Provider Demographics
NPI:1083693055
Name:BOWER, DANIEL LEON (DMD MS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:LEON
Last Name:BOWER
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 SHADOWMOSS DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5257
Mailing Address - Country:US
Mailing Address - Phone:321-317-8793
Mailing Address - Fax:
Practice Address - Street 1:1864 N ALAFAYA TRL STE 100
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-4733
Practice Address - Country:US
Practice Address - Phone:407-275-6626
Practice Address - Fax:407-275-9972
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0246811223S0112X
FLDN210821223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
000OTHMedicare UPIN